Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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27-OCTOBER-2008 MUHAMED AL-SAYED ABU-HAMADEH 75
YEARS PARAPLEGIA BELOW C5 AFTER RTA 25-OCTOBER-2008 WITH UNSTABLE FRACTURE
C6 AND EXTRUDED DISC C5-6.
The patient was admitted to
Al-Shmaisani hospital with clinical picture of
paraplegia below C5 after suffering RTA
25-October-2008. The patient was sent to the ICU
to observe the vital functions. His breathing
pattern was affected, but tolerable, due to
absence of chest wall movements. He was
hypertensive and he showed rhythmic
bradycardia. The patient has hallucinations 15
years ago. He has fracture left clavicle.
On examination: total
paraplegia of all muscles and sensation below
cervical spine was performed and showed
contusion of the spinal cord starting from C3
down to D3. The body of C6 was wedging and the
anterior osteophytes and the posterior calcified
longitudinal ligaments were fractured with huge
disc extrusion of the C5-6 compressing the
Osteophytectomy was performed
over C5-6-7. The extruded disc C5-6 was removed.
There was no tear in the dura, but it was
contused. All the steps of the operation were
performed with traction 5 KG with slight
extension. Before applying fixation, it was
necessary to put the neck in flexion position to
bring the anatomical structures in acceptable
position, after what using Hybrid cervical
miniplate with 6 screws were used to fix C5-6-7.
All the steps of the
operation were guided with image-intensifier.
Smooth recovery with the same neurological
The patient started to show
deterioration of his breathing pattern , for
what he was put in ventilator the morning of
30-October-2008. The patient was taken to the
operating room and tracheostomy and continuous
drainage of the lumbar CSF was achieved by
inserting tube subdurally in the lumbar spine,
using Touhy needle gauge 14.
The patient has severe
contusion of the spinal cord. The aim of surgery
to put the patient in chair as soon as possible.
The degree of improvement
in the future will depend upon the recovery of the spinal
The patient has obesity and
diabetes mellitus and hypertension. These
factors playing a major role in the prognosis.
Since the chest wall muscles were paralyzed and
the huge abdomen played a critical role in
deteriorating his breath pattern.
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .